A rapid staging system for predicting mortality from HIV-associated community-acquired pneumonia

Ahsan M. Arozullah*, Jorge Parada, Charles L. Bennett, Maria Deloria-Knoll, Joan S. Chmiel, Laura Phan, Paul R. Yarnold

*Corresponding author for this work

Research output: Contribution to journalArticle

26 Scopus citations

Abstract

Study objective: Community-acquired pneumonia (CAP) accounts for an increasing proportion of the pulmonary infections in individuals with HIV infection. During the mid-1990s, hospital mortality rates for HIV-associated CAP ranged from 0 to 28%. While hospital differences in case mix may account for mortality rate variation, few methods to evaluate illness severity for HIV-associated CAP have been reported previously. The study objective was to develop a staging system for categorizing mortality risk of patients with HIV-associated CAP using information available prior to hospital admission. Design/setting/patients: Retrospective medical records review of 1,415 patients hospitalized with HIV-associated CAP from 1995 to 1997 at 86 hospitals in seven metropolitan areas. Measurements: In-patient mortality rate. Results: Hierarchically optimal classification tree analysis was used to develop a preadmission staging system for predicting inpatient mortality. The overall inpatient mortality rate was 9.1%. The significant predictors of mortality included the presence of neurologic symptoms, respiratory rate ≥ 25 breaths/min, and creatinine > 1.2 mg/dL. The model identified a five-category staging system, with the mortality rate increasing by stage: 2.3% for stage 1, 5.8% for stage 2, 12.9% for stage 3, 22.0% for stage 4, and 40.5% for stage 5. The classification accuracy of the model was 85.2%. Conclusions: Our staging system categorizes inpatient mortality risk for patients with HIV-associated CAP using three routinely available variables. The staging system may be useful for guiding clinical decisions about the intensity of patient care and for case-mix adjustment in future studies addressing variation in hospital mortality rates.

Original languageEnglish (US)
Pages (from-to)1151-1160
Number of pages10
JournalCHEST
Volume123
Issue number4
DOIs
StatePublished - Apr 1 2003

Keywords

  • Community-acquired pneumonia
  • HIV
  • Hospital mortality

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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